Response to Correspondence re ‘Predicting outcomes in older patients undergoing vascular surgery using the Hospital Frailty Risk Score’ by Guijuri et al

Dear Editor, We thank Gujjuri and colleagues for their considered comments on our article1 and welcome their agreement on the importance of frailty when evaluating adverse surgical outcomes. Concerns regarding the applicability of the Hospital Frailty Risk Score (HFRS) as a clinical assessment tool are noted. We also agree the HFRS has considerable limitations if applied as a bedside frailty assessment tool, especially due to the considerable time lag associated with coded data, meaning the HFRS could only be available during subsequent hospital admissions. We acknowledge that our decision to include elective and emergency admissions is limiting but for the purposes of validation, sought to replicate the same statistical methods as the original development cohort, which included patients of both admission acuities. Future studies could improve the HFRS by differentiating admission acuity and applying the HFRS to patient subgroups where frailty is recognised as more prevalent. Despite this, the need for a validated frailty prediction score for use in routinely-collected health data is addressed by our validation of the HFRS in older vascular surgical patients. We advocate the HFRS is an important tool for comparing patient subgroups in population-wide surgical outcome studies and for health service planning. Frailty-directed interventions, such as comprehensive geriatric assessment, are resource intensive and not all patients require the same degree of intervention. It is possible for hospitals to apply the HFRS to their own ICD-10-AM coded data to identify the prevalence of frailty in their patient population. Understanding the prevalence of patients at high-risk of frailty within a hospital jurisdiction or surgical specialty can assist service-level planning to direct resources towards patient subgroups who are most likely to benefit.